MULTIPLE MYELOMA

Summary

The veteran, who served in the United States Army Reserve from November 1964 to November 1966 and May 1968 to October 1969, appeals the denial of an increased rating for his service-connected multiple myeloma, entitlement to Total Disability based on Individual Unemployability (TDIU), and entitlement to Special Monthly Compensation (SMC) prior to February 23, 2023. The Board denied the increased rating for myeloma, finding the veteran already received the maximum 100% rating and no exceptional circumstances warranted extraschedular consideration. The Board also denied TDIU, concluding that while the veteran's myeloma impacted his ability to work, his overall service-connected disabilities, combined with his extensive education, skills, and ability to engage in some activities like travel and exercise, did not render him unemployable. The Board denied SMC prior to February 23, 2023, finding the veteran did not meet the criteria for a 60% or higher disability in addition to his 100% myeloma rating, nor was he permanently housebound. The Board remanded the issues of service connection for left and right lower external popliteal nerve neuropathy, finding the prior VA medical opinions inadequate as they did not consider the impact of the service-connected myeloma and prostate cancer on these conditions. The Board noted that the veteran's claims were advanced on the docket due to his age.

Rationale

Veteran already rated at maximum 100% for symptomatic myeloma.; No evidence of exceptional or unusual circumstances for extraschedular consideration.

Full Decision Text

Citation Nr: A26040487
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 260202-629450
DATE: April 30, 2026

ORDER

Entitlement to an initial rating in excess of 100 percent for service-connected multiple myeloma (myeloma) is denied.

Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied.

Entitlement to an effective date earlier than February 23, 2023 for special monthly compensation based on housebound status pursuant to 38 U.S.C. § 1114(s) (SMC) is denied.

REMANDED

The issue of entitlement to service connection for left lower external popliteal nerve neuropathy is remanded.

The issue of entitlement to service connection for right lower external popliteal nerve neuropathy is remanded.

FINDINGS OF FACT

1. The Veteran is in receipt of the maximum rating for service-connected myeloma, there is no evidence or contention that the schedular rating for myeloma is inadequate, and there is no legal or factual basis to awarded an effective date earlier than November 1, 2021 for service-connected myeloma.

2. The evidence of record persuasively weighs against a finding that the Veteran's service-connected disabilities prevent him from securing or following in substantially gainful employment.

3. The combined rating for the Veteran's service-connected disabilities other than his total rating for myeloma prior to February 23, 2023 were less than 60 percent, and the evidence of record persuasively weighs against a finding that the Veteran was permanently housebound prior to February 23, 2023.

CONCLUSIONS OF LAW

1. The criteria for an initial rating in excess of 100 percent for myeloma are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.117, Diagnostic Code (DC) 7712.

2. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.16.

3. The criteria for entitlement to SMC prior to February 23, 2023, have not been met. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army Reserve from November 1964 to November 1966 and May 1968 to October 1969. 

This appeal is being processed under the modernized review system, commonly referred to as the "AMA," as established by the Veterans Appeals Improvement and Modernization Act of 2017. 115 Pub. L. No. 55, 131 Stat. 1105.

This matter comes before the Board of Veterans' Appeals (Board) on appeal of July 2025 (as to myeloma only) and January 2026 (as to all other issues) rating decisions issued by a Department of Veterans Affairs (VA) regional office, an agency of original jurisdiction (AOJ).

The Veteran initiated this appeal by submitting a February 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), and elected the Direct Review docket. 

As to the myeloma issue only, the Board may only consider the evidence of record at the time the AOJ issued the July 2025 decision. 38?C.F.R. § 20.301.

The January 2026 rating decision as to the other issues was responsive to the Veteran's October 2025 VA Form 20-0996, Decision Review Request: Higher-Level Review, seeking review of a January 2025 rating decision. Therefore, the Board may only consider the evidence of record at the time the AOJ issued the January 2025 decision. 38?C.F.R. § 20.301.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in the adjudication of this appeal. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, the Veteran may file a VA Form 20-0995, Decision Review Request: Supplemental Claim, and submit or identify this evidence. 38 C.F.R. § 3.2501.
. Therefore, the Board may only consider the evidence of record at the time the AOJ issued the January 2025 decision. 38?C.F.R. § 20.301.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in the adjudication of this appeal. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, the Veteran may file a VA Form 20-0995, Decision Review Request: Supplemental Claim, and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a VA Form 20-0995 are included with this decision.

Because the Board is remanding some of the claims, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

The one year period since of the July 2025 and January 2026 rating decisions on appeal has not yet elapsed, implicating the Veteran's right to select a different Board review option by submitting a new VA Form 10182 within one year from the date the AOJ mailed the decision on appeal, or within 60 days of the date the Board received the January 2026 VA Form 10182, whichever date is later, has also elapsed. 38 C.F.R. § 20.202(c)(2); see also Williams v. McDonough, 37 Vet. App. 305, 311 (2024) ("If 'VA says in a regulation that it intends to give a veteran [time to modify his or her NOD], we assume that means VA will give the veteran [that time]' ") (internal citations omitted). Under Williams, the Board would have to wait until no earlier than January 27, 2027 to issue a decision on the matter. 

The Board sua sponte advanced this appeal on the docket (AOD) due to the Veteran's advanced age. See 38 C.F.R. § 20.800(c)(1). Further, the Veteran's last period of military service was in October 1969, over 50 years ago, and therefore his claims concern alleged injuries or diseases that occurred over 50 years ago. In addition, the Veteran chose the Direct Review docket, implying that he chose this option so that the Board would issue its decision quickly. See February 2026 VA Form 10182 ("Choosing this option often results in the Board issuing its decision most quickly"). Finally, the Board notes the Veteran has pursued the claims since as early as November 2021. See November 2021 VA Form 21-526EZ Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ) (constituting the Veteran's initial claim for entitlement to service connection for myeloma).

The Board recognizes the tension that the instant appeal causes between Williams and expeditious treatment of an appeal as authorized by Congress in 38 U.S.C. § 7112 and implemented in 38 C.F.R. § 20.800(c). As in Williams, this Veteran also chose the Direct Review docket, also received a similar notification letter, and also had been pursuing his claims for years. A distinction in this appeal, however, is that it has been advanced on the docket, and that consideration was not discussed in the Williams case. To avoid the risk of "ignor[ing] Congress [... and] circumstances [that] are the opposite of expedited treatment and promptness," Wiggins v. Collins, 38 Vet. App. 341 (2025) (J. Jaquith, dissenting), the Board finds that the status of this case as being AOD warrants the Board issue its decision as soon as possible without waiting until the period to request to switch dockets elapses as contemplated under Williams.

Increased Rating

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. 

If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. §
 the period to request to switch dockets elapses as contemplated under Williams.

Increased Rating

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. 

If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. Any reasonable doubt regarding a degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3.

The Board acknowledges that the Veteran is competent to describe the symptoms he is experiencing and has experienced in the past, but there is no evidence of record demonstrating that he has the necessary medical expertise to establish the severity of his conditions. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007). Thus, the Veteran's lay statements are not competent to establish the severity of his conditions. For that reason, the Board must rely on the medical evidence of record. The Board clarifies it is not disregarding the Veteran's lay statements, but rather, the Veteran's lay statements alone are not competent to establish the severity of his conditions. See Miller v. Wilkie, 32 Vet. App. 249 (2020).

1. The issue of entitlement to an initial rating in excess of 100 percent for service-connected myeloma.

The Veteran contends that he is entitled to an initial rating in excess of 100 percent for service-connected myeloma. See February 2026 VA Form 10182.

The Veteran's service-connected myeloma is rated under 38 C.F.R. § 4.117, DC 7712. Symptomatic multiple myeloma warrants a 100 percent rating. Asymptomatic, smoldering, or monoclonal gammopathy of undetermined significance (MGUS) warrants a noncompensable rating. Note 1 states that current validated biomarkers of symptomatic multiple myeloma and asymptomatic multiple myeloma, smoldering, or MGUS are acceptable for the diagnosis of multiple myeloma as defined by the American Society of Hematology (ASH) and International Myeloma Working Group (IMWG). Note 2 states that the 100 percent evaluation shall continue for five years after the diagnosis of symptomatic multiple myeloma, at which time the appropriate disability evaluation shall be determined by mandatory VA examination. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 C.F.R. §§ 3.105(e) and 3.344(a)-(b).

In all claims for increased ratings, the Veteran is presumed to be seeking the maximum possible evaluation. See A.B. v. Brown, 6 Vet. App. 35 (1992).

In a July 2025 rating decision, responsive to a July 2025 VA examination, the AOJ continued the Veteran's 100 percent rating for service-connected myeloma because he continued to have symptomatic myeloma. No clear and unmistakable errors have been shown to rebut this finding; therefore, this favorable finding is binding on the Board. 38 C.F.R. § 3.104(c).

The Veteran's service-connected myeloma has been rated 100 percent since November 1, 2021.

A 100 percent rating is the highest rating available for service-connected myeloma. The Veteran has not asserted that the schedular rating is inadequate, nor has the Board found that the evidence of record shows such exceptional or unusual circumstances to consider whether the Veteran is entitled to extraschedular consideration for service-connected myeloma. See Thun v. Peake, 22 Vet. App. 111, 115-116 (2008); 38 C.F.R. § 3.321(b)(1).

Further, the Board has considered whether the Veteran is entitled to an earlier effective date for service-connected myeloma. The current effective date for service-connected myeloma is November 1, 2021, the day the AOJ received his November 1, 2021 VA Form 21-526EZ claiming entitlement to service connection for myeloma. There is no evidence of record indicating any factual or legal basis that could award an effective date earlier than November 1,
 entitled to extraschedular consideration for service-connected myeloma. See Thun v. Peake, 22 Vet. App. 111, 115-116 (2008); 38 C.F.R. § 3.321(b)(1).

Further, the Board has considered whether the Veteran is entitled to an earlier effective date for service-connected myeloma. The current effective date for service-connected myeloma is November 1, 2021, the day the AOJ received his November 1, 2021 VA Form 21-526EZ claiming entitlement to service connection for myeloma. There is no evidence of record indicating any factual or legal basis that could award an effective date earlier than November 1, 2021.

The Board has considered entitlement to a TDIU and SMC below, which will consider service-connected myeloma. See October 2025 VA Form 20-0996. Otherwise, the Veteran has not raised any specific contentions as to how he is entitled to an increased rating in excess of 100 percent for service-connected myeloma.

In light of the above, the Board denies entitlement to an initial rating in excess of 100 percent for service-connected myeloma.

2. The issue of entitlement to a TDIU.

3. The issue of entitlement to SMC prior to February 23, 2023.

The Veteran contends that he is entitled to a TDIU, and, separately, entitled to SMC prior to February 23, 2023. See October 2025 VA Form 20-0996; February 2026 VA Form 10182. The Veteran has raised the issue of entitlement to a TDIU at several junctures, including due to all service-connected disabilities, see February 2023 VA Form 21-8940 Veterans Application for Increased Compensation based on Unemployability (VA Form 21-8940), service-connected myeloma alone, see July 2023 VA Form 21-8940, and some, but not all, service-connected disabilities. See October 2023 and February 2026 VA Forms 10182. The Board will afford the Veteran the benefit of the doubt and consider all of his service-connected disabilities in its analysis.  

Further, the Veteran argued that entitlement to a TDIU was not a moot issue because the Veteran's myeloma is not permanent and total, and the Veteran became too disabled to work because of his service-connected disabilities, noting the Veteran's liver cirrhosis alone caused unemployability. October 2025 VA Form 20-0996. Id.

TDIU

A TDIU may be granted where the schedular rating is less than 100 percent and the veteran is unable to secure or follow a substantially gainful occupation as a result of their service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. 

The sole fact that a veteran is unemployed or has difficulty obtaining employment is insufficient for TDIU purposes. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The evidence must show the veteran is incapable of performing the physical and/or mental acts required by employment by reason of their service-connected disabilities. 

That the phrase "unable to secure and follow a substantially gainful occupation" in 38 C.F.R. § 4.16 has two components: economic and non-economic components. Ray v. Wilkie, 31 Vet. App. 58, 73-74 (2019). The economic component contemplates an occupation earning more than marginal income, outside of a protected environment, as determined by the United States Department of Commerce, Bureau of the Census, as the poverty threshold for one person. The non-economic component contemplates the veteran's ability to follow and secure employment. In this respect, due consideration must be given to their history, education, skill, and training; physical ability, both exertional and non-exertional, to perform the types of activities (e.g., sedentary, light, medium, heavy, or very heavy) required by the occupation at issue; and mental ability to perform the activities required by the occupation at issue. Given the term sedentary is generally defined as "doing or requiring much sitting" and "not physically active," the Board finds that sedentary employment is a job where the worker primarily sits down and is not physically active. See MERRIAM-WEBSTER, https://www.merriam-webster.com/dictionary/sedentary (last visited March 3, 2026).

The U.S. Court of Veterans Claims (Court) defined "employment in a protected environment" within 38 C.F.R. § 4.16(a) to unambiguously mean "a lower-income position that,
 heavy) required by the occupation at issue; and mental ability to perform the activities required by the occupation at issue. Given the term sedentary is generally defined as "doing or requiring much sitting" and "not physically active," the Board finds that sedentary employment is a job where the worker primarily sits down and is not physically active. See MERRIAM-WEBSTER, https://www.merriam-webster.com/dictionary/sedentary (last visited March 3, 2026).

The U.S. Court of Veterans Claims (Court) defined "employment in a protected environment" within 38 C.F.R. § 4.16(a) to unambiguously mean "a lower-income position that, due to the veteran's service-connected disability or disabilities, is shielded in some respect from competition in the employment market." LaBruzza v. McDonough, 37 Vet. App. 111, 123 (2024).

The appropriate factors for consideration are the veteran's employment history, educational and vocational attainment and any other factors bearing on the issue. 38 C.F.R. §§ 3.341, 4.16. However, a veteran's age or the impairment caused by nonservice-connected disabilities may not be considered. 38 C.F.R. §§ 3.314, 4.16, 4.19. 

As a preliminary matter, for consideration of a TDIU on a schedular basis, the veteran must meet the disability rating percentage threshold. 38 C.F.R. § 4.16(a). If a veteran is service connected for only one disability, that disability must be rated at 60 percent disabling or more. If a veteran is service-connected for two or more disabilities, at least one of the disabilities must be rated at 40 percent disabling or more and the additional service-connected disabilities must bring the combined disability rating to 70 percent or more.

If a veteran does not meet the percentage threshold for consideration of a TDIU on a schedular basis under 38 C.F.R. § 4.16(a), consideration of a TDIU on an extraschedular basis may be warranted. 38 C.F.R. § 4.16(b). The Board may consider a TDIU on an extraschedular basis in the first instance and is no longer required to refer the matter to the Director, Compensation Service for consideration in the first instance. See Witkowski v. Collins, 38 Vet. App. 459 (2025).

SMC

SMC is payable under 38 U.S.C. § 1114(s)(1) when a veteran has a single service-connected disability rated as 100 percent and has additional service-connected disability or disabilities independently ratable at 60 percent or more, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems. For the purpose of meeting the first criterion, a rating of 100 percent may be a schedular rating, an extraschedular rating, or a temporary total rating. SMC is also payable under 38 U.S.C. § 1114(s)(2) if the veteran has a service-connected disability rated as total and, by reason of the veteran's service-connected disability or disabilities, the veteran is permanently housebound.

A TDIU rating may satisfy the first statutory requirement that the veteran have a total rating, but only if the veteran's unemployability is based on a single disability.  Bradley v. Peake, 22 Vet. App. 280, 293 (2008). A TDIU rating based on multiple underlying disabilities cannot satisfy § 1114(s)'s requirement of "a service-connected disability." Buie v. Shinseki, 24 Vet. App. 242, 250 (2010).

In addressing an increased rating claim, SMC benefits are to be accorded when a veteran becomes eligible, without need for a separate claim. Akles v. Derwinski, 1 Vet. App. 118, 121 (1991). More broadly, the Board must consider all theories of entitlement raised by the claimant or the evidence of record as part of the non-adversarial administrative adjudication process. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009).

Period of Review Analysis

The Veteran first raised entitlement to a TDIU in a February 2023 VA Form 21-8940 Veterans Application for Increased Compensation based on Unemployability (VA Form 21-8940) claiming unemployability for all service-connected disabilities. The AOJ denied the claim in a May 2023 rating decision, considering the Veteran's prostate cancer. In a September 2023 rating decision, the AOJ found the issue moot, considering the Veteran's 100 percent rating for
 claimant or the evidence of record as part of the non-adversarial administrative adjudication process. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009).

Period of Review Analysis

The Veteran first raised entitlement to a TDIU in a February 2023 VA Form 21-8940 Veterans Application for Increased Compensation based on Unemployability (VA Form 21-8940) claiming unemployability for all service-connected disabilities. The AOJ denied the claim in a May 2023 rating decision, considering the Veteran's prostate cancer. In a September 2023 rating decision, the AOJ found the issue moot, considering the Veteran's 100 percent rating for myeloma. The Veteran filed an October 2023 VA Form 10182, arguing that TDIU was not moot.

In a November 27, 2023 decision, the Board previously denied entitlement to a TDIU. The November 27, 2023 Board decision has not been vacated such that the Board can disregard its findings. See Zuniga v. Comm'r of Soc. Sec., 772 F. App, 870, 871 (11th Cir. 2019) (internal citations omitted) ("[A] vacated opinion or order is 'officially gone' [...]"). Previously issued Board decisions will be considered binding only with regard to the specific case decided. 38 C.F.R. § 20.1303. Here, because the Board issued a decision on this exact issue for this Veteran, and that decision has not been vacated, the Board finds that the November 27, 2023 Board decision as to the issue of entitlement to a TDIU is binding on the Board in the instant appeal. 

Within one year of the November 27, 2023 Board decision, the Veteran filed a December 2023 VA Form 20-0995, seeking review of the Veteran's service-connected liver condition and also citing the November 27, 2023 Board decision and entitlement to a TDIU ("TDIU is intertwined with the liver claim rating"). The AOJ denied the claims in an April 2024 rating decision. 

Within one year of the April 2024 rating decision, the Veteran filed an April 2024 VA Form 10182, seeking Board review of the April 2024 rating decision. In June 2024, the Board remanded the issue of entitlement to a TDIU, noting the issue was inextricably intertwined with the issues of entitlement to service connection for left and right lower external popliteal nerve neuropathy. The AOJ denied entitlement to a TDIU in the January 2025 rating decision. The Veteran filed the October 2025 VA Form 20-0996, leading to the January 2026 rating decision on appeal. Consequently, the period on review extends back to November 28, 2023, the day after the November 27, 2023 Board decision, to the present. See 38 U.S.C. § 5110 (b)(3); Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010).

Analysis

TDIU

Turning to the Veteran's claim for entitlement to a TDIU, the Board must first consider whether the Veteran is entitled to a TDIU on a schedular or extraschedular basis. From September 2012, the Veteran was service-connected for prostate cancer (10 percent); from November 1, 2021, the Veteran was service-connected for myeloma (100 percent); from March 2022, the Veteran was service-connected for prostate cancer (40 percent); and from February 23, 2023, the Veteran was service-connected for the liver (70 percent) and for anxiety (30 percent). The Veteran is also service-connected for an abdominal surgical scar and erectile dysfunction at noncompensable ratings. For the period from November 1, 2021, the Veteran met the percentage threshold for consideration of a TDIU on a schedular basis because he had a disability, namely, myeloma, rated at 60 percent disability or more.

The Board now considers the economic component of entitlement to a TDIU. The February 2023 and July 2023 VA Forms 21-8940 of record indicated he last worked full-time in March 2008 as a business owner in retail from 1991 to March 2008 making $5,416.66 per month at 50 hours per week. He also worked seasonally as a tax preparer from 2009 to 2012, making $1,000 per month at 20 hours per week. Prior to his retail job, he worked full-time in accounting from 1966 to
 schedular basis because he had a disability, namely, myeloma, rated at 60 percent disability or more.

The Board now considers the economic component of entitlement to a TDIU. The February 2023 and July 2023 VA Forms 21-8940 of record indicated he last worked full-time in March 2008 as a business owner in retail from 1991 to March 2008 making $5,416.66 per month at 50 hours per week. He also worked seasonally as a tax preparer from 2009 to 2012, making $1,000 per month at 20 hours per week. Prior to his retail job, he worked full-time in accounting from 1966 to 1992. See May 2023 VA examination for scars. He also stated he worked part-time 20 hours per week as an equity investor, though it was unclear when or how much income he made from that position. Id. He reported different dates in which he became too disabled to work, noting April 2012 in the February 2023 VA Form 21-8940 and November 2020 in the July 2023 VA Form 21-8940. He stated that the photo business closed permanently in 2008 because of the "national economic downturn" and the decreased need for photo processing services. March 2023 VA examination for mental health disorders. The Veteran stated he retired from the workforce completely after he finished his work as a tax preparer in 2012, and he was in his early seventies at that point. Id. A private medical record indicated that the Veteran worked as a chief executive officer (CEO) for a number of small companies, though without specific information as to when, how many hours, and how much income, and he retired in 2008. See May 2021 Primary Care appointment note; see also July 2023 VA examination for mental disorders (indicating that he worked as a comptroller for a few companies).

As to the non-economic component of a TDIU, the Board first looks at the Veteran's history, education, skills, and training. The evidence of record indicates that he completed high school and earned a bachelor's of science in accounting and two master's degrees in taxation and business administration. See November 1966 DD-214; July 2023 VA Form 21-8940. As discussed above, he worked as a CEO, and engaged in accounting, tax preparation, and photo business management. While in the military, he served as a unit commander and a maintenance and repair officer. See November 1966 and October 1969 DD-214s.

As to physical abilities, his service-connected liver condition causes him ascites, abdominal pain, malaise, weight loss, and difficulty with lifting and walking for long periods. See May 2023 and January 2024 VA examination for liver conditions. As to his service-connected myeloma, a VA examiner noted that ongoing treatment impacted his ability to work in "any setting" as time off work would be "frequently required," though the Veteran otherwise denied calling out sick due to myeloma. See March 2023, May 2023, and September 2023 VA examinations for hematologic and lymphatic conditions. He stated that due to his myeloma symptoms and diagnosis, four or five years prior, he "had it made" and "had a good life" and could travel without a problem, but he engaged in fewer activities and had to go to the supermarket and rare occasions out to dinner, but not that often. See March 2023 VA examination for mental disorders. He also lost 45 pounds after getting his myeloma diagnosis, but he gained back some of that weight. Id. As to service-connected prostate cancer, the Veteran suffering from a voiding dysfunction, requiring voiding intervals between either 1-2 hours (December 2022 VA examination) or 2-3 hours (May 2023 VA examination) during the day time and nighttime awakening to void five times or more, though the VA examiner noted no functional impact from prostate cancer, and the Veteran denied calling out sick due to prostate cancer. See December 2022 and May 2023 VA examinations for male reproductive organ conditions. In a November 2023 private appointment note, the Veteran stated that he was engaged in a "sedentary lifestyle" at home, including endorsing "great sleep," usually a total of seven hours with four hours uninterrupted, then he voids, then three hours, walks around his apartment complex and stairs, including three flights in stairs in his home, and he travels to Aruba several weeks per year in April and May. See also November 2020 private cancer treatment notes (noting the Veteran was "very active" at baseline but was not exercising at a gym due to the COVID-19
 the Veteran denied calling out sick due to prostate cancer. See December 2022 and May 2023 VA examinations for male reproductive organ conditions. In a November 2023 private appointment note, the Veteran stated that he was engaged in a "sedentary lifestyle" at home, including endorsing "great sleep," usually a total of seven hours with four hours uninterrupted, then he voids, then three hours, walks around his apartment complex and stairs, including three flights in stairs in his home, and he travels to Aruba several weeks per year in April and May. See also November 2020 private cancer treatment notes (noting the Veteran was "very active" at baseline but was not exercising at a gym due to the COVID-19 epidemic); February 2021 private cancer treatment notes. There is no evidence that the Veteran's abdominal scar or erectile dysfunction cause functional impact. See December 2022 May 2023, and September 2023 VA examinations. 

As to mental abilities, the evidence of record indicates that the Veteran's anxiety disorder caused a depressed mood, chronic sleep impairment, mild memory loss, and disturbances of motivation and mood. See July 2023 VA examination for mental disorders. He denied any suicidal or homicidal ideation and any psychotic symptoms, and the VA examiner assessed he was able to manage his own financial affairs. Id.; see also March 2023 VA examination for mental disorders. 

In light of the above, the Board finds that the Veteran's service-connected disabilities do not cause him to be unemployable. The Veteran demonstrated the ability to engage in some activities - exercise, travel, ambulation, climbing stairs - that suggest he would be able to engage in some type of sedentary employment, especially considering his employment history, training, and skills. At best, the Veteran's service-connected myeloma, while symptomatic, could cause him unemployability, given the ongoing treatment for his myeloma would impact his ability to work in any setting as time off of work would be frequently required. See March 2023 VA examination. However, his service-connected myeloma is already rated as total, and therefore, the Board cannot award a total disability rating to a disability already rated total. See 38 C.F.R. § 4.16(a) (a TDIU may be assigned "where the schedular rating is less than total") (emphasis added).

The Board is again remanding entitlement to service connection for left and right lower extremity popliteal neuropathy. While the Board had previously remanded entitlement to a TDIU as inextricably intertwined with entitlement to service connection for these conditions, see June 2024 Board decision, because there is no evidence of record that these conditions cause any functional impact such as to affect the Veteran's employability, see January 2024 VA examinations (the VA examiner answered "No" as to functional impact), the Board declines to again remand entitlement to a TDIU intertwined with these conditions because no benefit would flow to the Veteran to further delay adjudication of entitlement to a TDIU. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (holding that unnecessary burdens should not be imposed on VA without a benefit flowing to the veteran).

In light of the above, the Board denies entitlement to a TDIU.

SMC

Turning to the Veteran's claim for entitlement to SMC, the Board notes that the Veteran is already in receipt of SMC from February 23, 2023, see April 2024 rating decision, and thus the Board will consider entitlement to SMC prior to February 23, 2023.

Considering first the statutory basis for entitlement to SMC, see 38 U.S.C. § 1114(s)(1), the Board notes that the Veteran's service-connected disabilities other than myeloma constituted less than 60 percent prior to February 23, 2023, as the Veteran was rated 10 percent for prostate cancer from September 2012 and 40 percent from March 2022, and his only other service-connected disabilities (other than myeloma) during this period were his surgical scar and erectile dysfunction rated as noncompensable. Therefore, the Board does not find that SMC is warranted prior to February 23, 2023 on a statutory basis.

Considering next the permanently housebound basis for entitlement to SMC, see 38 U.S.C. § 1114(s)(2), the Board notes that the evidence of record shows the Veteran was moving about his apartment complex, taking trips to Aruba, and otherwise had no indication that he was permanently housebound. At worst, he indicated that he did not go out as much because of his myeloma, but a reduction in activities does not equate to "permanently housebound." Further, the
eloma) during this period were his surgical scar and erectile dysfunction rated as noncompensable. Therefore, the Board does not find that SMC is warranted prior to February 23, 2023 on a statutory basis.

Considering next the permanently housebound basis for entitlement to SMC, see 38 U.S.C. § 1114(s)(2), the Board notes that the evidence of record shows the Veteran was moving about his apartment complex, taking trips to Aruba, and otherwise had no indication that he was permanently housebound. At worst, he indicated that he did not go out as much because of his myeloma, but a reduction in activities does not equate to "permanently housebound." Further, the Veteran did not contend he was permanently housebound. Therefore, the Board does not find that SMC is warranted prior to February 23, 2023 on a permanently housebound basis.

In light of the above, the Board denies entitlement to service connection for SMC.

REASONS FOR REMAND

1. The issue of entitlement to service connection for left lower external popliteal nerve neuropathy.

2. The issue of entitlement to service connection for right lower external popliteal nerve neuropathy.

Remand by the Board in the AMA is proper for a correction of duty to assist errors occurring prior to the date of the AOJ decision on appeal (i.e., pre-decisional duty to assist errors). 38 C.F.R. § 20.802(a). The Board is required to consider all theories of entitlement to VA benefits that are either raised by the claimant or reasonably raised by the record. DeLisio v. Shinseki, 25 Vet. App. 45, 53 (2011) ("[T]he Secretary generally must investigate the reasonably apparent and potential causes of the Veteran's condition and theories of service connection that are reasonably raised by the record or raised by a sympathetic reading of the claimant's filing").

In an October VA Form 20-0996, the Veteran contended that his neuropathy was caused by his "two different cancers," presumably his myeloma and prostate cancer conditions. Neither the January 2024 nor August 2024 VA medical opinions of record as to these conditions considered the Veteran's service-connected myeloma and prostate cancer conditions and whether the nerve conditions were due to or aggravated by these conditions. Here, the AOJ committed a pre-decisional duty to assist error by failing to provide an adequate medical opinion as to the Veteran's left and right lower external popliteal nerve neuropathy. Remand is necessary to obtain an adequate VA medical opinion. 

The matters are REMANDED for the following action:

1. Obtain an addendum medical opinion (and, if necessary, schedule the Veteran for a VA examination) with a qualified clinician who has reviewed the claims file to determine the nature, extent, and etiology of the Veteran's left and right lower external popliteal nerve neuropathy. The evidentiary record, including a copy of this remand, must be made available for the reviewing clinician. The examiner should consider the relevant lay evidence of record and relevant medical evidence of record and render an opinion. The examiner is asked to provide a response to the following: 

(a.) Is the Veteran's left and right lower external popliteal nerve neuropathy at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) due to any other service-connected conditions? 

(b.) Is the Veteran's left and right lower external popliteal nerve neuropathy at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) aggravated, by any other service-connected conditions?

 

 

Paul R. Casey

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Peña, Alan M.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.